BACKGROUND:We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HAART and identified determinants of the incidence. METHODS:We analyzed the incidence of TB during the first 3 years after initiation of HAART among 17,142 treatment-naive, AIDS-free persons starting HAART who were enrolled in 12 cohorts from Europe and North America. We used univariable and multivariable Poisson regression models to identify factors associated with the incidence. RESULTS:During the first 3 years (36,906 person-years), 173 patients developed TB (incidence, 4.69 cases per 1000 person-years). In multivariable analysis, the incidence rate was lower for men who have sex with men, compared with injection drug users (relative rate, 2.46; 95% confidence interval [CI], 1.51-4.01), heterosexuals (relative rate, 2.42; 95% CI, 1.64-3.59), those with other suspected modes of transmission (relative rate, 1.66; 95% CI, 0.91-3.06), and those with a higher CD4+ count at the time of HAART initiation (relative rate per log2 cells/microL, 0.87; 95% CI, 0.84-0.91). During 28,846 person-years of follow-up after the first 6 months of HAART, 88 patients developed TB (incidence, 3.1 cases per 1000 person-years of follow-up). In multivariable analyses, a low baseline CD4+ count (relative rate per log2 cells/microL, 0.89; 95% CI, 0.83-0.96), 6-month CD4+ count (relative rate per log2 cells/microL, 0.90; 95% CI, 0.81-0.99), and a 6-month HIV RNA level >400 copies/mL (relative rate, 2.21; 95% CI, 1.33-3.67) were significantly associated with the risk of acquiring TB after 6 months of HAART. CONCLUSION:The level of immunodeficiency at which HAART is initiated and the response to HAART are important determinants of the risk of TB. However, this risk remains appreciable even among those with a good response to HAART, suggesting that other interventions may be needed to control the TB epidemic in the HIV-infected population.

Objective: To assess the natural story of HIV-associated affective and cognitive disorders and the relationship with clinical, pharmacological, immunological and behavioural factors.Method: A total of 395 HIV-positive patients, naive to Highly Active Antirectroviral therapy (HAART), with no severe psychiatric disorders have been enrolled in the Neuro-ICONA Study. All participants were administered a comprehensive data collection instrument including an addiction behaviour survey, a medical problem list, a psychiatric assessment, a validated neuropsychological test battery.Results: The global prevalence of cognitive impairment and of prominent depressive symptomatology were 17.9 and 15.5%, respectively. A significant difference in the prevalence of prominent depressive symptomatology was observed between patients in HAART and those not taking HAART(14.1 vs. 23.8%; P =0.05).Conclusion: Depressive and cognitive disorders affect a substantial proportion of HIV-seropositive subjects. The prevalence of prominent depressive symptomatology appears to significantly vary in relationship to the therapeutic protocol.

Physicians estimate their patients' adherence to medications, and base decisions about treatment on these estimates. In HIV, misjudgment of patient adherence can have adverse consequences, including withholding of therapy, unnecessary changes in therapy, or unnecessary laboratory testing. A review of the literature demonstrates that physicians are often inaccurate in estimating patient adherence with antiretroviral therapy. These findings have implications for practice. Standardized methods for adherence assessment are currently available that can be used to enhance physicians' ability to understand adherence behavior and barriers. The patient-physician relationship presents a unique setting for improving adherence. The authors propose interventions to improve adherence within the context of the patient-physician relationship at the physician level, interpersonal level, and organizational level. Improved communication, including discussion about patient lifestyle and preferences, can facilitate a frank exchange of information, negotiation, and a spirit of cooperation. Active patient participation in the decision-making process is crucial.

Objectives: To identify variables predictive of nonadherence to highly active antiretroviral therapy (HAART) and to assess whether self-reported symptoms or medication side effects are related to adherence.Design: Cross-sectional multicenter study Adherence Italian Cohort Naive Antiretrovirals [AdICONA] within the Italian Cohort Naive Antiretrovirals (ICONA).Methods: Participants receiving HAART completed a 16-item self-administered questionnaire to assess nonadherence in the last 3 days as well as the type and intensity of 24 common HIV- and HAART-related symptoms experienced during the last 4 weeks.Results: From May 1999 to March 2000, 358 persons were enrolled: 22% reported nonadherence and were less likely to have HIV RNA < 500 copieshnl (odds ratio = 0.51; 95% confidence interval: 0.31-0.85). Frequency of moderate/severe symptoms or medication side effects in nonadherent participants ranged from 3.6% to 30%, On univariate analysis, nausea, anxiety, confusion, vision problems, anorexia, insomnia, taste perversion, and abnormal fat distribution were significantly associated with nonadherence. Nonadherent persons had a higher mean overall symptom score (12.3 +/- 91 versus 8.1 +/- 6.6; p < .001) and mean medication side effect score (2.9 +/- 2.7 versus 1.9 +/- 1.9; p < .001) when compared with adherent participants. In the multivariate analysis, nausea (p = .003); anxiety (p = .006); younger age (p = .007); unemployment (p < .001); not recalling name, color, and timing of drugs (p = .009); running out of pills between visits (p < .002); and being too busy (p = .03) were independently associated with nonadherence in the last 3 days.Conclusions: In addition to patient characteristics, medication-related variables, and reasons for nonadherence, patient-reported symptoms and medication side effects were significantly associated with adherence to HAART.

Liuzzi, G.; Bagnarelli, P.; Chirianni, A.; Clementi, M.; Nappa, S.; Cataldo, P. Tullio; Valenza, A.; Piazza, M. Author Information

We have shown that HCV-RNA is resistant to drying at room temperature for at least 48 hours. This is a factor which could influence the diffusion of the virus in the general population, which epidemiological studies have shown to be surprisingly high. It should be considered in evaluating the importance of the inapparent parenteral routes of transmission.

The Yeast phase of Histoplasma capsulatum has stringent growth requirements. Transition from mycelium to yeast takes place only in the presence of cysteine and can be blocked by the -SH groups inhibitor p-chloromercury-phenylsulfonic acid (PCMS). Ultrastructural studies show lysis and degeneration of PCMS treated mycelium grown at 37 degrees C for 24 hours. Only 50% of PCMS treated mycelium appear degenerate when grown at 34 degrees C for 24 hours. The remaining cells have normal morphology with only slight changes in the cell wall structure. The effect of PCMS is permanent and hereditary. Mice injected with PCMS treated mycelium do not develop disease and are resistant to virulent strains of H. capsulatum when challenged.

A case of acute steatosis in pregnancy featuring unusually severe cholestasis is discussed with details of the successful outcome for mother and foetus. The correspondence between clinical picture, histological and ultrasound findings is reported together with a detailed review of the latest reports in the literature and what they reveal about the true incidence of the disease, the variability of the clinical picture, whether and when it is better for both mother and child to interrupt.

Intranuclear particles of 23-27 nm diameter have been repeatedly demonstrated in the nuclei of hepatocytes of patients with non-A, non-B hepatitis and of experimentally infected chimpanzees; however, their specificity has been challenged since they have also been observed in other pathological conditions and in healthy volunteers. We have conducted an ultrastructural study of liver biopsies from 10 patients with chronic active non-A, non-B hepatitis. The intranuclear particles, which were observed in all patients, were classified according to the aggregation patterns described by De Vos. Eight patients (80%) had particles of type 2. A reevaluation our proceeding data on Delta hepatitis demonstrated that no particles of type 2 were present. These results support the hypothesis that only type 2 particles are markers of non-A, non-B hepatitis.

Contamination by hepatitis B surface antigen in dental surgeries Dental surgeries are believed to be high risk areas for hepatitis B virus infection by virtue of possible contamination by droplets of blood and Environmental surfaces and instruments testedfor hepatitis B surface antigen (HBsAg) by radioimmunoassay Counts/min in Mean counts/min in samples positive seven negative Environmental surfaces No of samples No of samples for HBsAg* controls in kit or instruments tested positive for HBsAg (A) (B)

Journal of Clinical UltrasoundVolume 13, Issue 7 p. 491-493 Case Report Tuberculous mesenteric lymphadenitis clinically presenting as abdominal mass: CT and sonographic findings Guglielmo Borgia MD, Corresponding Author Guglielmo Borgia MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalyClinic of Infectious Diseases, Second Medical School of Medicine, University of Naples, Via Sergio Pansini, 5, 80131 Naples, ItalySearch for more papers by this authorRocco Ciampi MD, Rocco Ciampi MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this authorSalvatore Nappa MD, Salvatore Nappa MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this authorGianfranco Vallone MD, Gianfranco Vallone MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this authorInes Marano MD, Ines Marano MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this authorJane Crowell PhD, Jane Crowell PhD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this author Guglielmo Borgia MD, Corresponding Author Guglielmo Borgia MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalyClinic of Infectious Diseases, Second Medical School of Medicine, University of Naples, Via Sergio Pansini, 5, 80131 Naples, ItalySearch for more papers by this authorRocco Ciampi MD, Rocco Ciampi MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this authorSalvatore Nappa MD, Salvatore Nappa MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this authorGianfranco Vallone MD, Gianfranco Vallone MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this authorInes Marano MD, Ines Marano MD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this authorJane Crowell PhD, Jane Crowell PhD Clinic of Infectious Diseases and Department of Radiology I and II, Second Medical School of Medicine, University of Naples, 80131 Naples, ItalySearch for more papers by this author First published: September 1985 https://doi.org/10.1002/jcu.1870130712Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Al-Bahrani ZR, Al-Saleem T: Intestinal tuberculosis in Iraq: A study of 50 cases. Int Surg 67: 483, 1982. 2 Listernick R, Shulman S: Tuberculous mesenteric lymphadenitis in children. Pediatr Infect Dis 2: 237, 1983. 3 Bhansali SK: Abdominal tuberculosis. Am J Gastroenterol 67: 324, 1977. 4 Stanley RJ: Fluid characterization with computed tomography, in AA Moss, HI Goldberg (eds): Computed Tomography, Ultrasound and X-Ray: An Integrated Approach. New York, Academic Press, 1980, p 65. 5 Epstein BM, Mann JH: CT abdominal tuberculosis. Am J Roentgenol 139: 861, 1982. Citing Literature Volume13, Issue7September 1985Pages 491-493 ReferencesRelatedInformation

We report a morphometric study on the effect of 3-palmitoyl-(+)-catechin on phagocytic activity of latex particles by Kupffer cells in guinea pig liver. We found an increase in the density of latex particles in Kupffer cells of animals treated with 3-palmitoyl-(+)-catechin. The volume and density of Kupffer cells of treated animals increased (p less than 0.01); there was no significant difference in surface density of the plasma membrane. None of the parameters measured was altered in endothelial cells. These results show that 3-palmitoyl-(+)-catechin produces morphological and functional changes in Kupffer cells.

The investigators report an ultrastructural study of a case of primary biliary cirrhosis histologically in stage II (Scheuer), a rare disease which has not been investigated extensively at the ultrastructural level. Biliary canaliculi are dilated and microvilli are scarce. Large granular formations are observed in the perisinusoidal cytoplasm. The plasma membrane between adjacent hepatocytes appears convoluted. The ultrastructural alterations of the biliary canaliculi which we observed have been described in the literature in cholestatic patients and ascribed to cholestasis. Our patients, however, has never suffered episodes of jaundice or itching and has no histological signs indicating cholestasis. We suggest that these are precocious alterations which precede the appearance of clinical and histological signs of cholestasis. It is necessary to study other cases in order to evaluate the significance of the large granular formations and the changes observed in the plasma membrane.

An unusual case of obstructive jaundice due to metastatic pancreatic plasmacytoma is described. Initially post-transfusion hepatitis was suspected in the patient who suffered from multiple myeloma (IgA) and had received numerous transfusions for severe anemia. Clinical and laboratory findings indicated obstructive jaundice and the ecographic examination showed a dishomogeneous mass at the level of the pancreas. The investigators suggest that after this type of ecographic finding a percutaneous biopsy should be performed eliminating exploratory laparotomy, a high risk procedure in this type of patient, and eventually radiotherapy should be initiated since this type of tumor is radiosensitive.